Spotlight on Equity Center Trainee: Fola May, MD, MPhil
During her residency training in internal medicine and fellowship training in gastroenterology, Fola May witnessed first-hand the ugly effects of colorectal cancer among African Americans.
“African American patients are more likely to get colorectal cancer and to die of it, are more likely to present at advanced stages, and are less likely to receive appropriate screening tests than white patients,” says Dr. May.
She applied for and was awarded a fellowship in the Specialty Training and Advanced Research (STAR) training program and funding on a National Institutes of Health (NIH) training grant to study colorectal cancer inequities in-depth while earning a PhD in Health Policy and Management at the UCLA Fielding School of Public Health.
“I really wanted to understand the problem well,” says Dr. May. To do so, her three-part doctoral thesis combines multiple methods to demonstrate a complete portrait of colorectal cancer (CRC) inequities in the US. Part 1 analyzes SEER data from 1975 to 2011 to characterize colorectal cancer disparities trends at the national level. Part 2 is a systematic review of the literature to summarize the evidence around the reasons for low rates of CRC screening among African Americans, grouping the reasons according to the Institute of Medicine model of inequities into patient-level, provider-level, and systems-level factors. Part 3 is a retrospective database study of predictors of colorectal cancer screening at the West Los Angeles Veterans Affairs Hospital, where she worked as a gastroenterology fellow.
“The West LA VA was a great laboratory to examine barriers to screening. Disparities at the national level arise in part because African Americans are less likely to have health insurance and more likely to be underinsured than whites. But there are minimal variations in access to care for veterans, and many African American vets are served at the West LA VA. That makes it a good place to explore the influence of individual- and provider-level factors that keep African Americans from getting screened.”
She found that African American veterans were significantly less likely to have any kind of colorectal cancer screening test than other veterans, even when they has similar access to care. African American veterans that did receive a screening test were screened significantly later than other veterans.
“My work at the Equity Center has helped me understand the problem of colorectal cancer screening disparities from the researcher, provider, and patient perspective. I hope to use what I’ve learned to move forward with designing interventions to improve colorectal cancer screening rates among African Americans.”